By Benjamin J. Luft 404 pp, $20 New York, NY, Greenpoint Press, 2011 ISBN-13: 978-0-9832-3702-0 On the morning of September 11, 2001, I was attending a research seminar in Boston when my cell phone rang. I looked at the caller ID and saw that it was a friend in Manhattan. Not wanting to disturb the seminar, I blocked the call and returned my attention to the presentation on bone marrow stem cells. A few minutes later, the same friend in Manhattan called again. I was poised to ignore the call but then saw that others in the room were receiving messages. A researcher near me had his phone to his ear. “A plane hit the World Trade Center,” he announced. I answered my call. In a trembling voice, my friend said, “I can't believe it. I saw one plane crash into the Twin Towers. And I just saw a second one.” Images of the September 11, 2001, World Trade Center terrorist attack. Left, New York City firefighters arriving on the scene; right, firefighters bearing one of their own. Reproduced courtesy of the photographer, Steven Spak. The presenter stopped speaking, and soon all of us around the conference table tried to make sense of what we had heard. I wondered whether I knew anyone who was in the buildings or on the planes. Days later, I learned how chance had saved the life of a friend. She had traveled east to bring her son to college and was booked to return to California from Newark. Arriving at the airport early, she was told by the agent at the gate that there was plenty of room if she wanted to take the plane home before her scheduled one. In today's frantic world, always rushing to get somewhere, most readily would have changed their ticket rather than wandering the Newark airport. But my friend decided to wait, and that choice saved her life, because the earlier plane was one of those highjacked. I also heard a story with a different ending about another friend. A math wiz, he was a successful investor who worked from his home in a suburb of New York, rarely traveling to the city. But on the morning of September 11, he had a meeting at the World Trade Center about an impending deal. He perished in the attack. The stories of those who survived and those who did not brought into tight focus how individuals go about their lives with an assumption of control and certainty, living as if each day will unfold largely like the last. That is a highly functional assumption, but for the nation, it was shattered on that September morning a decade ago. All witnessed order turned to chaos, a sense of safety replaced by threat and fear. Physicians are more familiar than most with how the comfortable equilibrium of daily life can be upended. One day a patient is at work or playing golf and the next day learns that an episode of dizziness is attributable to a brain tumor or that fleeting chest pain indicates an aortic aneurysm. At the moment, mortality becomes palpable. Such moments mark individuals who fall ill; at times, they affect society as a whole. September 11, 2001, was such a moment. So, it is most fitting that a physician has worked to capture a unique dimension of September 11 and its aftermath. At the time of the attack, Benjamin Luft was the chair of medicine at Stony Brook Medical School on Long Island. In this deeply moving and illuminating book, he describes how he organized a medical team to care for the expected “droves of wounded” from the disaster. But, “No patients arrived that day. People either escaped the buildings, or they were killed. The hospitals in the city were able to handle the comparatively few wounded. They didn't need our help out on the Island.” Several days later, Luft visited what was called “The Pile,” the devastation at Ground Zero. “As a trained clinician and scientist,” he continues, “I observed a situation containing all the ingredients needed for the development of significant mental and physical disease as well as social disruption to those who responded. Returning to work the following day, I decided to change course. We established a voluntary clinic for responders from the community, both professional and nonprofessional, to help meet their medical and psychological needs.” After overcoming barriers that Luft attributes to “politics, avarice, and fear” he succeeded in this effort, and now more than 6000 responders are served by the integrated medical, psychiatric, and social services of the Stony Brook program. Luft and his fellow faculty also created a seminar course for medical students titled “9/11: The Anatomy of a Health Care Disaster.” Luft and colleagues aimed to educate future physicians about the complex effects of such catastrophes on individuals and the culture at large. One can imagine such a course filled with statistics on the incidence of posttraumatic stress disorder, data from clinical trials about cognitive behavioral therapy for the responders, and numbers on risk for airways disease attributable to exposure to particulate matter from The Pile. All of this science is highly appropriate for such a medical school course. But Luft writes that at the end of semester, the students observed live interviews of 9/11 responders. “The impact of the interviews was profound beyond our expectations. Highly intelligent, extremely rational, scientifically trained medical students (and their professors) were left with their mouths agape, not knowing how to respond except with tears and thanks.” With time, physicians learn that stories from their patients make concrete and compelling the experience of illness; patient narratives communicate a human dimension that can never be distilled into numbers or graphs, or made “significant” simply with P values. Physicians also know the unique gift bestowed on them when patients open up and reveal the deep corners of their experience under the extreme conditions of illness, their inspiring courage and resilience, as well as their profound pain and despair. After that visceral classroom experience, Luft and his colleagues developed their oral history project, collecting the stories from responders that comprise this book. Each narrative is prefaced with an explanatory note that frames the facts of that individual's work on September 11 and then life in its aftermath. Luft has done a remarkable job of providing just enough information and commentary to introduce readers to the responders and then allowing the responders' own words to speak in poignant and meaningful ways. This rhetorical approach narrows the degree of separation between those who experienced September 11 from afar and those who directly saw and touched and smelled the destruction. This oral history will stand as a unique legacy from that most awful September day, stories brought to life by a physician with the skills of close listening and keen observation, moved from his clinic onto the printed page. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
JAMA – American Medical Association
Published: Sep 14, 2011